Ccrnspontonre. A CASE OF FATAL THERMAL FEVER. To the Editor
of
the
"
Indian Medical Gazette
Sir,?In response to your invitation, in respect to " A Case of Fatal Thermal Fever 1" published by Dr. Gribbon in the current number of your issue, I beg you will kindly favor me with space to submit my opinion on it. The case, doubtless, must have been puzzling, but I may be excused the suggestion, that digital examination per vaginam would, I fancy, have been of some aid if not to clear all doubts as to the diagnosis ; as I am inclined to think, from the history given, that the case was one probably of Uterine Haemorrhage. The question of ruptured womb causing it can at the most, in the absence of further obstetric and gynaecological history, be
logically hypothetical.
My opinion is based upon the following reasons from the information supplied by the author (1) The age of the woman?that of child bearing life ; (2) gravid condition at the seventh month of utero-gestation ; (3) the fact of pregnancy seems moreover to have been corroborated by a deceptive, a, though sometimes symptom.?" She told a neighbour she had not' felt the child' since the day before," i. e. 10th of June : in other words, Mrs. S. was used to its movements in utero before that day, and its sudden stillness naturally drew, as it ordinarily would, her attention. (4) We have the account.?" On the 10th she got a fright from the horse in her ghari becoming restive, and she jumped out twice." (5.) The fact of Mrs. S.'s remark deferred to in (3) having been subsequent to the fright and the jumping out of the carriage. (6.) The symptoms observed on the 13th June were not altogether unlike what may have been the consequence of haemorrhage?abortion with or without placenta previa or the grave injury to the womb above suggested. In India I
Septemkeu 2,
CORRESPONDENCE.
1878.]
inclined to the belief that European women, espemuch to the effects of malaria, its cachexy, are prone, though not always, to suffer from a sanguineous discharge during gestation. This may, perhaps, have been the case with Mrs. S. in her previous pregnancies (if any): if it were so, it may have been that it was on that account that she did not attach to it sufficient importance as to mention it to her medical attendant. Or it may have been that she did not even notice^ her linen soiled, the hemorrhage having been internal?into the peritoneum. (7.) The cramps may be explained as caused by direct pressure of the gravid uterus or the escape of its contents causing pressure or reflex irritation, and consequent spasms. 1 have elsewhere,0 in your journal, alluded to the possibility of such a coincidence, and I also remember another case which came under my own observation. This was that of a married lady who had been away from her husband for some years, and who at a weak moment had unfortunately given in to temptation with the result that she found herself with child, and in order to conceal this fact from her husband, whom she was shortly to rejoin, she, at a more unfortunate moment, sought the service of an abortion-procurer, which evenfirst tually, after much suffering, cost her her life. At my 4 visit my patient complained of what she called only a touch of rheumatism on the back,' and tried to lead me altogether on a wrong track, under the impression, presumably, that anything given for the object of relieving the pain of her assumed ailment, would also cure the real complaint?caused by a criminal act with risk to herself. During the few minutes I was with her 1 noticed what appeared to me to be nothing else but I asked her a few questions (with true labour pains. the hope of their throwing some light on the subject, and to indicate to me the line of practice I should adopt) such as if she felt sick when she last menstruated, if there was any discharge of blood, and the like. To all these she was determined to give very evasive negatives, but the expression of her face evinced unmistakably that she felt her real condition recognized, at all events strongly suspected. I ordered absolute rest, with cloths constantly wrung out of iced or cold water to be applied to the belly. I also prescribed some astringents combined with largish opiates. At my second visit, to which I was suddenly summoned, I found my patient altogether blanched, with sunken eyes, cold clammy skin, husky voice in whispers, small weak thready pulse and some dyspnoea; in short I mays ay that this woman had all the external signs of grave hfemorrhage. I urged the absolute necessity of a digital examination, to which she expressed her reluctance. At my evening visit that day I was informed that no urine had been voided, and I obtained her consent then to withdraw it with catheter, and it was during this catheterism that I availed myself of the opportunity and obtained ample evidence to confirm my original opinion. The case proved fatal from metritis with complications. In conclusion I must solicit the favour of your criticism on this opinion as to the nature of the case under discussion. am
cially if exposed and consequently
I am,
Sir,
Your most humble servant, .
1n..
August, 1878.
Jno. C. Lucas, Bo. Medical Service.
P. S. As to the suppression of urine mentioned m tiie case, I believe it may Lave been simply a symptom of collapse in uterine, as in any other, haemorrhage, or rupture, or, like the cramps, it may have been due to mechanical pressure of the gravid uterus itself, or from the escape of its contents from rupture. The pressure the kidneys themselves, or it may may have been on * Uterine Physiology and Pathology and their effects system, Vol. xii., June 2nd, pp. 181-182.
on
the nervoua
257
have been that it caused obstruction (in the ureters) to the onward flow of urine to the bladder, or it mayhave been that, had a p. m. been made, both these reasons viz collapse and mechanical pressure may have been found to have co-operated simultaneously. J. L. '
of
the
"
Indian Medical Gazette
Sir,?In response to your invitation, in respect to " A Case of Fatal Thermal Fever 1" published by Dr. Gribbon in the current number of your issue, I beg you will kindly favor me with space to submit my opinion on it. The case, doubtless, must have been puzzling, but I may be excused the suggestion, that digital examination per vaginam would, I fancy, have been of some aid if not to clear all doubts as to the diagnosis ; as I am inclined to think, from the history given, that the case was one probably of Uterine Haemorrhage. The question of ruptured womb causing it can at the most, in the absence of further obstetric and gynaecological history, be
logically hypothetical.
My opinion is based upon the following reasons from the information supplied by the author (1) The age of the woman?that of child bearing life ; (2) gravid condition at the seventh month of utero-gestation ; (3) the fact of pregnancy seems moreover to have been corroborated by a deceptive, a, though sometimes symptom.?" She told a neighbour she had not' felt the child' since the day before," i. e. 10th of June : in other words, Mrs. S. was used to its movements in utero before that day, and its sudden stillness naturally drew, as it ordinarily would, her attention. (4) We have the account.?" On the 10th she got a fright from the horse in her ghari becoming restive, and she jumped out twice." (5.) The fact of Mrs. S.'s remark deferred to in (3) having been subsequent to the fright and the jumping out of the carriage. (6.) The symptoms observed on the 13th June were not altogether unlike what may have been the consequence of haemorrhage?abortion with or without placenta previa or the grave injury to the womb above suggested. In India I
Septemkeu 2,
CORRESPONDENCE.
1878.]
inclined to the belief that European women, espemuch to the effects of malaria, its cachexy, are prone, though not always, to suffer from a sanguineous discharge during gestation. This may, perhaps, have been the case with Mrs. S. in her previous pregnancies (if any): if it were so, it may have been that it was on that account that she did not attach to it sufficient importance as to mention it to her medical attendant. Or it may have been that she did not even notice^ her linen soiled, the hemorrhage having been internal?into the peritoneum. (7.) The cramps may be explained as caused by direct pressure of the gravid uterus or the escape of its contents causing pressure or reflex irritation, and consequent spasms. 1 have elsewhere,0 in your journal, alluded to the possibility of such a coincidence, and I also remember another case which came under my own observation. This was that of a married lady who had been away from her husband for some years, and who at a weak moment had unfortunately given in to temptation with the result that she found herself with child, and in order to conceal this fact from her husband, whom she was shortly to rejoin, she, at a more unfortunate moment, sought the service of an abortion-procurer, which evenfirst tually, after much suffering, cost her her life. At my 4 visit my patient complained of what she called only a touch of rheumatism on the back,' and tried to lead me altogether on a wrong track, under the impression, presumably, that anything given for the object of relieving the pain of her assumed ailment, would also cure the real complaint?caused by a criminal act with risk to herself. During the few minutes I was with her 1 noticed what appeared to me to be nothing else but I asked her a few questions (with true labour pains. the hope of their throwing some light on the subject, and to indicate to me the line of practice I should adopt) such as if she felt sick when she last menstruated, if there was any discharge of blood, and the like. To all these she was determined to give very evasive negatives, but the expression of her face evinced unmistakably that she felt her real condition recognized, at all events strongly suspected. I ordered absolute rest, with cloths constantly wrung out of iced or cold water to be applied to the belly. I also prescribed some astringents combined with largish opiates. At my second visit, to which I was suddenly summoned, I found my patient altogether blanched, with sunken eyes, cold clammy skin, husky voice in whispers, small weak thready pulse and some dyspnoea; in short I mays ay that this woman had all the external signs of grave hfemorrhage. I urged the absolute necessity of a digital examination, to which she expressed her reluctance. At my evening visit that day I was informed that no urine had been voided, and I obtained her consent then to withdraw it with catheter, and it was during this catheterism that I availed myself of the opportunity and obtained ample evidence to confirm my original opinion. The case proved fatal from metritis with complications. In conclusion I must solicit the favour of your criticism on this opinion as to the nature of the case under discussion. am
cially if exposed and consequently
I am,
Sir,
Your most humble servant, .
1n..
August, 1878.
Jno. C. Lucas, Bo. Medical Service.
P. S. As to the suppression of urine mentioned m tiie case, I believe it may Lave been simply a symptom of collapse in uterine, as in any other, haemorrhage, or rupture, or, like the cramps, it may have been due to mechanical pressure of the gravid uterus itself, or from the escape of its contents from rupture. The pressure the kidneys themselves, or it may may have been on * Uterine Physiology and Pathology and their effects system, Vol. xii., June 2nd, pp. 181-182.
on
the nervoua
257
have been that it caused obstruction (in the ureters) to the onward flow of urine to the bladder, or it mayhave been that, had a p. m. been made, both these reasons viz collapse and mechanical pressure may have been found to have co-operated simultaneously. J. L. '
